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FOR OFFICE USE: .........I................................. .....................................I..... .......... APPLICATION FOR SANITATION PERMIT Permit No. ................................—.............. (Complete-in Duplicate) ..................... ............... ....... This Permit Expires 1 Year From Date issued Date Issued 215?-_�,Y`1 Application is hereby made to the San Joaquin Local Health District for a permit to construct an This lapPlicafion is made in compliance with County Ordinance No. 549. sLiuta It the work rein described. 7& IV U151- (2,0-3 JOB'XDDRESS AND OCAT ON. Owner's Name....._.-- .. & ----- .......... ................. ............................ Phone..........--............... Addres&........ .................... .............. ....................... Contractor's Name...---'--- ..... ... . ..........--------*............ ........ ... Phone................................ Installation will serve: Residence urApartmenf ❑ House.....0... Commercial 0 Trailer Court 0 Motel 0 Other 0 Number of living units; ..4 Number of bedrooms-1.... Number of baths jk.. .. .%Am-.V. ... ................ Wafer Supply: Public system E] Community system 0 Private ET'*`6epth to Water Table - ft - Character of soil to a depth of 3 feet- Sand El Gravel 0 Sandy Loam �y Loam 01 Clay 0 Adobe 0 Hardpan C] Previous Application Made: (If yes,date...... ----- -__ ) No 0 New Construction: Yes [-] No ❑ FHA/VA: Yes [I No❑ TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sapti T Distance from nearest well---_V-20..�..Distance from foundaf No, of compartments..........7........Size r,4.k1.V.1_A_4.'Liquid depth........ ....... . ......Ca aci DisposaLoKielcl: Distance from nearest well Distance from foundation...../o..........Distance to nearest lot line-X........... De Width of trench....A.........................Number of lines...... Length of each line.. ....?401 Type of filter material........ .._d__t_.Depfh of filter material-----...........Total length-----76.-,YA'....................... -1 Seepage Pit: Distance to nearest well................... ..Distance from foundation....................Distance to nearest lot line................. . * 0 El Number of pits_. ..................Lining material....._................ Size: Diameter...._.__..........................Depth...................._.......... 0 Cesspool; Distance from nearest well ................Distance from foundation-------...........Lining material................_.__._-.............. 0 Size: Diameter. .. .......... -----MaptK....................................__............Liquid Capacity...........................gals. Privy:. Distance from nearest well.................................................Distance from nearest building......_....-_...........-.___............ 0; Distance to nearest lot line............................. ----------_-- Remodeling and/or repairing (describe):....--'---'-"-'---.....:....... ---_-----------------------..........__.................................................... -------------------- .................................................. ................. ............................................------------------------- ........... ........ .............................------------------------ ................................................................................................................................... ........................................................................................ ............. .............................................I......................................... --- 11herela certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinaInces, Late laws, and ru s and regulations of the San Joaquin Local Health District. (Signed)..._.......-- ------------- ------ - --------------- ___11-1r Contractor) _AtBY:----------------------(11,:>�" ..........................((Title)----------------- ---------- ---- (Plot plan, showing ium of lot, location of system in relation-to wells, buildings, etc., can 69 placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_..... -_------------- --- ......_--- DATE......ZZ-f:m.�.7n&_7 REVIEWEDBY........................ .......... ..................... ............. ................................ DATE_.......------ ..................................BUILDING PERMIT ISSUED__..... ........._-------------------__-_-------..........................._......._ DATE._....--- .......................... Alferalions and/or recommendations:-----_--..._ ..................__...................................-------------------- ..... .................................. 11 _.................................................................................I................................ ............................ _1...... ... ................................ ...........4-................I............ .........--------------------------------------------------------------_--_- .................. .........----- ---_:................................... ..._..---c:-----'---------......................... .......................................................................................... --------------- ........ ......... ................. ........................................ ..-/..'........_...........--......._--------_-------- 11-.......................................................... _.. ...........-..............-----`- FINAL ..................................FINAL INSPECTION Z Date_ -..Z 7__&,,_.�..1.......................... SAN JOAQUIN LOCAL HEALTH DISTRICT 160I E.H.i.h.Ay.. 300 Wo,t 0.1,St,..t 124 Symmore Sfr.ol 205 W.0 91h St,.0 St"Irton,CoNfolnia Lod( California mci",c., California T,.cy,California E.H.9 20A 1.67 Vanquo,d Pres: